Evaluating the Use of a Topical Vapocoolant to Reduce Pain during Intravenous Insertions: The Patients' and Nurses' Perspectives

Transcription

1 The Henderson Repository is a free resource of the Honor Society of Nursing, Sigma Theta Tau International. It is dedicated to the dissemination of nursing research, researchrelated, and evidence-based nursing materials. Take credit for all your work, not just books and journal articles. To learn more, visit Item type Format Title Presentation Text-based Document Evaluating the Use of a Topical Vapocoolant to Reduce Pain during Intravenous Insertions: The Patients' and Nurses' Perspectives Authors Inman, Cecilia M.; Bisson, Jennifer M. Downloaded 28-Apr :15:48 Link to item

2 Evaluating the Use of a Topical Vapocoolant to Reduce Pain during Intravenous Insertions: The Patients and Nurses Perspectives Cecilia Inman BSN, RN-BC and Jennifer Bisson BSN, RN E 06 Pain Reduction and Management November 9, 2015; 1:45 PM-3:00 PM

3 Learning objectives Describe and discuss the literature on topical vapocoolant and how it is related to evidence-based practice Evaluate and discuss the use of a vapocoolant during intravenous (IV) insertions in terms of patient s pain experience and nurse s perspective related to patient safety and application procedure Disclosure There was no conflict of interest or financial gain for this project 2

4 Quick Poll: 1) How many of you use a topical vapocoolant for intravenous insertions in your current practice? 2) How many of you are familiar with topical vapocoolant?

5 Background Intravenous catheter insertion, a common procedure performed by health-care providers, can cause pain, anxiety, and stress for the patient resulting in dissatisfaction From a nursing perspective stress and anxiety may increase the unsuccessful attempts necessary to gain peripheral venous access (Page & Taylor, 2010) A topical vapocoolant, when applied to a procedure site, evaporates rapidly, decreasing the skin temperature, resulting in temporary interruption of the pain sensation (Page & Taylor, 2010). 4

6 Overview of the Literature Table 1. Appraisal of the available literature and Level/Strength of Evidence Author Celik et al. (2011) International Journal of Medical Sciences Page & Taylor (2010) British Journal of Anesthesia Armstrong, Young, & McKeown (1990) Canadian Journal of Anesthesia Setting and sample size 41 adult patients Age >18 Hemodialysis center 220 adults Age >18 Metropolitan emergency department 120 adults Gynecological day-surgical center Study design RCT RCT RCT Intervention Results Usefulness to practice 1) Vapocoolant topical spray 2) Lidocaine/ Prilocaine (EMLA cream) 3) Placebo cream 4) Control 1) Vapocoolent topical spray 2) Lidocaine SC 1) Vapocoolent spray 2) No treatment 3) Lidocaine SC Group 2 sig decreased pain compared to groups 1,3, and 4 Group 1 and 2 sig decreased pain compared to groups 3 and 4 Comparable effectiveness between group 1 and 2 in preventing mild to moderate pain Vapocoolent compared to lidocaine subcutaneously resulted in: Sig improved IV start success rate Sig < administration pain scores Group 2 sig < cannulation pain Group 2 administration pain comparable to group 1 cannulation pain No difference in patient satisfaction Group 3 sig decrease in vein visibility compared to groups 1 and 2 Group 1 and 2 sig ease of cannulating IV compared to group 3 Group 1 and 3 sig decreased cannulation pain compared to group 2 Strengths: Placebocontrolled Weaknesses: Wide variability between group 3 and 4 pain scores Strengths: Power analysis (110 per group) Weaknesses: Unblinded? bias Variable application techniques Strengths: Cannulation and assessment by one administrator Weaknesses: No power analysis Unblinded Strength of Evidence * II II II * Fineout-Overholt, Melnyk, & Schultz (2005) 5

7 Appraisal and Gaps in the Literature When compared to EMLA and Lidocaine, vapocoolants were significantly inferior in reducing pain on IV insertion Vapocoolant spray significantly reduces mild to moderate pain when compared to no treatment Clinical indications that the vapocoolent s easy application and no administration pain is a product advantage. Strengths & Weakness: Randomized control studies; unblinded Insufficient evidence supporting the use of topical vapocoolants in the adult population Nursing perspective of using a topical vapocoolant absent from literature 6

8 Purpose Compare the patient s perception of pain and the nurse s experience during the IV insertion process, with and with out the use of a topical vapocoolant 7

9 Methods Study Design and Data collection De-identified adult patient and nurse surveys were collected between March and September 2014 Patients and nurses perceptions of the IV catheter insertion process were compared with (n=51) and without (N=50) application of a topical vapocoolant Data collection tools were created to describe and compare: Patient perceptions related to pain level, nurse s skill level, satisfaction of IV insertion process Nurse perceptions of patient's pain level and satisfaction with IV catheter insertion process Data Analysis Descriptive statistical analysis was used to analyze data 8

10 Methods Intervention Institutional protocol for initiating an IV insertion was followed. Nursing education was provided to: Ensure proper application of the vapocoolant Address safety considerations that were implemented during the application process Ensure objectivity and clear criteria were applied to data collection tools 9

11 Results: Patient Demographics Table 2. Patients Demographic Variable No Vapocoolant (N=51) Vapocoolant (N=50) Patient Age Mean Std. Deviation Minimum Maximum The age of patients in the Vapocoolant group were (Mean 62.70, SD 9.92) not significantly different compared to patients in the control group (Mean 66.16, SD 10.78, p<0.068) 10

12 Results: Nursing Practice Regardless of an administration of a topical vapocoolant patients rated: The nurses skill level as very high Q: How skillful was a nurse performing the IV insertion? No vapocoolant (Mean 9.12, SD 1.83) vs. Vapocoolant (Mean 9.7, SD 0.61) An overall satisfaction with the IV insertion process. Q: How would you rate your satisfaction with IV insertion? No vapocoolant (Mean 8.43, SD 2.59) vs. Vapocoolant (Mean 8.68, SD 2.31) Results were unaffected by the: Size of the IV cannula (Mean=20.7, SD 1.0 vs. 20.5, SD 1.0) Number of attempts to establish IV access (Mean=1.7, SD 1.3 vs. 1.4, SD 0.8) Number of nurses attempting IV insertion (Mean=1.3, SD 1.0 vs. 1.2, SD 0.7) 11

13 Results: Patient Perception Table 3. Comparison of Patients Perceptions of Pain/Discomfort Pain/discomfort (0-10 rating scale with 0 = very comfortable, 10 = not comfortable) No Vapocoolant (N=51) Vapocoolant (N=50) Test Statistics Mean P < Std. Deviation Minimum 0 0 Maximum 10 9 Patients who did not receive the vapocoolant prior to the IV insertion reported higher levels of pain/discomfort compared to patients who received the vapocoolant 12

14 Nursing Considerations The nurses experiences and feedback included: Application and safety concerns: Stream unexpectedly diverts from intended site causing potential risk getting into a patient s and/or nurse s eye(s) Non-localized spray unnecessarily numbs wide area of skin Flammability of product in presence of oxygen Nurses reported that IV insertions were generally successful (96% to 98%) in both groups Therapy was delayed 20% of the time in the no vapocoolant group and 4% of the time in the vapocoolant group

15 Conclusions/Implications This project demonstrates the importance of clinical experts perspectives and feedback from a safety and satisfaction standpoint when implementing evidence-based practice. The learnings from this initiative are also demonstrating how staff nurses can make evidencebased decisions and practice changes by integrating evidence from literature with patient experience, and their own expertise. Patient Experience Research Evidence from Literature Evidence- Based Practice (EBP) Clinical Expertise Figure 1. Evidence-based practice in clinical settings (Fineout-Overholt, Melynk, & Schultz, 2005 ) 14

16 Conclusions/Implications (cont.) The findings of this project are confirming the benefits of a topical vapocoolent for IV insertions in adult patients The next steps include a re-assessment of use of this vapocoolant product and exploration of alternative solutions to resolve identified nursing concerns We continue using the tools for patients and nurses; collecting and analyzing data; comparing the findings, and strengthening our practices based on the evidence. 15

17 Reference Armstrong, P., Young, C., & McKeown, D. (1990). Ethyl chloride and venepuncture pain: A comparison with intradermal lidocaine. Canadian Journal of Anesthesia, 37(6), Celik, G., Ozvek, O., Mumtaz, Y, Duman, I., Ozbek, S. (2011). Vapocoolant spray vs. lidocaine/prilocaine cream for reducing the pain of venipuncture in hemodialysis patients: A randomized placebo-controlled crossover study. International Journal of Medical Sciences, 8(7), Fineout-Overholt E., Melnyk, B.M., Schultz, A. (2005). Transforming health care from the inside out: Advancing evidence-based practice in the 21 st century. Journal of Professional Nursing, 21(6), doi: /j.profnurs Page, D. E., & Taylor, D.M. (2010). Vapocoolant spray vs. subcutaneous lidocaine injection for reducing the pain of intravenous cannulation: A randomized controlled, clinical trial. British Journal Anesthesia, 105(4), Retrieved from Shah, V., Taddio, A., & Rieder, M.J. (2010). Effectiveness and tolerability of pharmacologic and combined interventions for reducing injection pain during routine childhood immunizations: systematic review and meta-analyses. Clinical Therapeutics, 31(2), S

18 Questions? Thank You!